Journal of surgical oncology
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The occurrence of postoperative chyle leak after neck dissection or vascular surgery of the subclavian and vertebral artery is a well-known but rare complication. The management of chyle leak ranges from utilizing a myriad of conservative procedures to surgical exploration. Occasionally on surgical exploration the chyle leak is diffuse and ligation of the bed of thoracic duct is not adroit to stopping the chyle leak. We describe a technique, which will be useful in this circumstance and in recurrent chyle leak after a previous exploration.
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The technique of right hepatic trisegmentectomy has been standardized for large tumors that involve the right lobe and extend into the medial segment of the left lobe. However, these tumors are deemed unresectable if they encroach across the falciform ligament into the left lateral segment. We report the technique of extended right trisegmentectomy in a patient with a large intrahepatic cholangiocarcinoma that involved the right lobe of the liver and extended into the medial and lateral segments of the left lobe. ⋯ The procedure allowed safe parenchymal dissection with preservation of the blood supply to Segments II and III. Furthermore, in situ hypothermic perfusion protected the remnant liver from the deleterious effects of warm ischemia during parenchymal dissection and facilitated postoperative recovery. To the best of our knowledge, this is the first report of extended right trisegmentectomy for the treatment of intrahepatic cholangiocarcinoma in the Western literature.
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The objective of the current study was to determine the significance of sarcomatoid differentiation as a prognostic factor for immunotherapy in metastatic renal cell carcinoma (RCC). ⋯ Our findings suggest that sarcomatoid differentiation is an important prognostic factor for immunotherapy in metastatic RCC.
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Carcinoma of the ampulla of Vater has a relatively higher resection rate, lower recurrence rate, and more favorable prognosis than other malignant tumors of the periampullary region. Because of the relative low incidence of carcinoma of the ampulla of Vater, there have been few reports on the patterns and risk factors of recurrence after curative resection. The aim of this study was to evaluate the patterns and risk factors of recurrence after curative resection of ampulla of Vater carcinoma. ⋯ Lymph node metastasis is the most important risk factor for recurrence after a curative resection. Also, the fact that a higher probability of recurrence is anticipated in cases of ulcer formation and poorly differentiated tumors, there exists a need for a close-up follow-up program.